Placement of 2 cages using navigation-guided biportal endoscopic transforaminal lumbar interbody fusion: illustrative case

BACKGROUND In recent developments, full endoscopic and unilateral biportal endoscopic (UBE) spine surgery have emerged to aid the transforaminal lumbar interbody fusion (TLIF) procedure. Yet, both approaches present a challenge due to limited space for cage insertion, potentially leading to complications such as cage subsidence or nonfusion in long-term assessments. Utilizing double cages may mitigate these concerns. This paper presents a unique case in which a patient successfully underwent computed tomography (CT) navigation–guided UBE-TLIF with 2 converging cages, highlighting the potential benefits and feasibility of this innovative approach. OBSERVATIONS A 59-year-old female diagnosed with degenerative spondylolisthesis at the L4–5 level underwent a UBE-TLIF. The operation is detailed step by step and supported by illustrative figures and surgical videos. Postsurgery results revealed a significant improvement in the patient’s condition, with the visual analog scale score decreasing from 7 to 3 on the first day, leading to a satisfaction rate of 90% at the last follow-up. LESSONS Utilizing endoscopic visualization complemented by contrast medium has substantially elevated the quality of disc preparation. From their observations, the authors affirm that the integration of intraoperative CT navigation systems significantly augments safety and pinpoint accuracy in UBE-TLIF procedures. The strategy of employing 2 converging cages through a unilateral technique stands as a practical solution, potentially optimizing the fusion outcomes of UBE-TLIF surgery.